NPIMap

Individual provider Active NPI

Leanna M McKenzie

  • Athletic Trainer
  • Dublin, GA
National Provider Identifier
1275935603
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AT002451 Issued in GA
Practice address
101 Fairview Park Dr
Dublin, GA 31021-2501
Phone
(478) 272-7494
Fax
(478) 272-2616
NPI assigned
Sep 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT002451 GA Primary

Addresses

Primary practice location

101 Fairview Park Dr
Dublin, GA 31021-2501

Mailing address

101 Fairview Park Dr
Dublin, GA 31021-2501
Phone (478) 272-7494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AT002451GAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Bass Physical Therapy and Rehabilitation Center Inc Past Accepting new patients
Bass Physical Therapy and Rehabilitation Center, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1275935603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212501",
            "telephone_number": "478-272-7494",
            "fax_number": "478-272-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212501",
            "telephone_number": "478-272-7494",
            "fax_number": "478-272-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "LEANNA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT002451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.